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This study evaluates whether the Cmax/MIC of bedaquiline and levofloxacin differs between MDR-TB patients who achieve sputum conversion and those who do not during the first four months. Using a cohort design in adults on an 18–24-month oral regimen, pharmacokinetic and MIC analyses were performed via LC-MS/MS and MGIT.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-peak-plasma-concentration-cmaxminimum-inhibitory-concentration-mic-of-bedaquiline-and-levofloxacin-research-article/408523/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-peak-plasma-concentration-cmaxminimum-inhibitory-concentration-mic-of-bedaquiline-and-levofloxacin-research-article/408523.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What was the main objective of the study?","Question",{"text":112,"@type":113},"To determine whether the Cmax/MIC of bedaquiline and levofloxacin differs between MDR-TB patients with sputum conversion and those without during the first four months of treatment in Indonesia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were drug plasma concentrations and MIC values measured?",{"text":117,"@type":113},"Plasma concentrations of bedaquiline and levofloxacin were measured using liquid chromatography–tandem mass spectrometry (LC-MS/MS), and MIC of individual drugs was determined using Mycobacterium tuberculosis isolates with liquid growth media (MGIT).",{"name":119,"@type":110,"acceptedAnswer":120},"What did the results show for bedaquiline and levofloxacin?",{"text":121,"@type":113},"Bedaquiline’s mean Cmax/MIC ratio was higher in the sputum conversion group (9.10 vs. 1.65), while levofloxacin showed a small, non-significant difference (45.64 vs. 41.72; p = 0.941).",{"name":123,"@type":110,"acceptedAnswer":124},"What conclusion was drawn regarding sputum conversion?",{"text":125,"@type":113},"The Cmax/MIC of bedaquiline was higher among patients with sputum conversion within the first four months, suggesting a potential relationship between bedaquiline Cmax/MIC and sputum conversion.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},408523,1790970638,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":143,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":149,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","OPEN ACCESS  \nCitation: Mariana N, Gayatri A, Widyahening IS, Bela B, Soedarsono S, Maemunah I, et al.(2025) The Peak Plasma Concentration (Cmax)/ Minimum Inhibitory Concentration (MIC) of bedaquiline and levofloxacin with special attention to the sputum conversion in the treatment of multidrug-resistant tuberculosis in Indonesia. PLoS One 20(12): e0336210 .  \n[https://doi.org/10.1371/journal.pone.0336210](https://doi.org/10.1371/journal.pone.0336210)  \n[Editor:](Editor: Saki Raheem)[ Saki Raheem](Editor: Saki Raheem), University of Westminster  \n-Regent Street Campus: University of Westminster, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND  \nReceived: May 26, 2025  \nAccepted: October 22, 2025  \nPublished: December 31, 2025  \nPeer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0336210  \nRESEARCH ARTICLE  \nThe Peak Plasma Concentration (Cmax)/Minimum Inhibitory Concentration (MIC) of bedaquiline and levofloxacin with special attention to the sputum conversion in the treatment of  \nmultidrug-resistant tuberculosis in Indonesia  \nNina Mariana1,2☯, Anggi Gayatri3☯, Indah Suci Widyahening4, Budiman Bela5, Soedarsono Soedarsono6, Iin Maemunah7, Rosamarlina Rosamarlina8, Vivi Setiawaty2, Vithal Prasad Myneedu9, Erni Juwita Nelwan10, Purwantyastuti Ascobat3☯*  \n1 Doctoral program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia,  \n2 Directorate Of Human Resources-Education and Research, National Infectious Disease CenterSulianti Saroso Hospital, Jakarta, Indonesia, 3 Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 4 Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 5 Department of Microbiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, 6 Sub-Pulmonology Department of Internal Medicine, Faculty of Medicine, University of Hang Tuah, Surabaya, Indonesia, 7 Department of Microbiology at Pulmonary Hospital, Dr. M. Goenawan Partoidigdo Hospital, Bogor, Indonesia, 8 Departement of Pulmonology, National Infectious Disease Center-Sulianti Saroso Hospital, Jakarta, Indonesia, 9 Department of Microbiology at Nepalgunj Medical College Teaching Hospital (NGMC), Nepal, 10 Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia  \n☯ These authors contributed equally to this work.  \n* [purwanty2703@yahoo.com](purwanty2703@yahoo.com)  \nAbstract  \nBackground  \nTuberculosis in Indonesia remains a serious public health concern, as the country has the third-largest number of multidrug-resistant tuberculosis (MDR-TB) patients in the world. Bedaquiline and levofloxacin are the primary drug regimen for MDR-TB treatment in Indonesia. This study aimed to investigate whether the Cmax/MIC of bedaquiline and levofloxacin differs between patients with sputum conversion and those without sputum conversion during the first four months of MDR-TB treatment in Indonesia.  \nMethods  \nA cohort study was performed in adult patients (18–65 years old) treated with the 18–24-month oral regimen. Patients were excluded if they were pregnant or HIV positive, with uncontrolled diabetes, or had any of the following severe conditions:  \ncancer, digestive, cardiovascular system disorders, hepatic, or renal problems. Two blood samples were collected to measure the plasma concentrations of bedaquiline  \nPLOS One | [https://doi.org/10.1371/journal.pone.0336210](https://doi.org/10.1371/journal.pone.0336210) December 31, 2025 1 / 15  \nCopyright: © 2025 Mariana et al. This is an open access article ","cbCaigJHZS4j2K47","https://ap.wps.com/l/cbCaigJHZS4j2K47","pdf",1027470,15,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusions","[{\"question\":\"What was the main objective of the study?\",\"answer\":\"To determine whether the Cmax/MIC of bedaquiline and levofloxacin differs between MDR-TB patients with sputum conversion and those without during the first four months of treatment in Indonesia.\"},{\"question\":\"How were drug plasma concentrations and MIC values measured?\",\"answer\":\"Plasma concentrations of bedaquiline and levofloxacin were measured using liquid chromatography–tandem mass spectrometry (LC-MS/MS), and MIC of individual drugs was determined using Mycobacterium tuberculosis isolates with liquid growth media (MGIT).\"},{\"question\":\"What did the results show for bedaquiline and levofloxacin?\",\"answer\":\"Bedaquiline’s mean Cmax/MIC ratio was higher in the sputum conversion group (9.10 vs. 1.65), while levofloxacin showed a small, non-significant difference (45.64 vs. 41.72; p = 0.941).\"},{\"question\":\"What conclusion was drawn regarding sputum conversion?\",\"answer\":\"The Cmax/MIC of bedaquiline was higher among patients with sputum conversion within the first four months, suggesting a potential relationship between bedaquiline Cmax/MIC and sputum conversion.\"}]","The Peak Plasma Concentration (Cmax)/Minimum Inhibitory Concentration (MIC) of bedaquiline and levofloxacin - Research Article | PDF",1790579655,38]